HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 16lC::,
:if.,
PERHIT HO.
t.ll_lr-I I C I F'HL I TY CmF RI'-ICH£,RRGE
DEPARTMENT OF HEALTH AND EtlVIRONMEHTAL PROTECTION
825 ~L~ STREET, RNCHORRGE, AK. 995~1
264-472¢1 ~c~ qSqS~
I..IELL PEF:rfl I T
APPLICANT
LOCFlTIOH
LEGAL
LEE SULLIVAN
~RGLE RIVER
L16 B2 ERGLE RIVER HTS
SR E:OX 197
LOT SIZE
16000 SQUARE FEET
MIHIMUM DISTRNCE BETHEEN R HELL AND ANY OH-SITE SEHRGE DISPOSAL SYSTEM IS
IQQ FEET FOR R PRIVATE HELL~ OF:
:L5_n TO 2Q_A FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL.
WELL LOGS ARE REQUIRED RHD MUST BE RETURHED TO THE DEPRRTHENT HITHIH 3Q DAYS
OF THE HELL COHPLETION.
OTHER REOUIREMEHTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRAHS ARE
AVAILABLE TO IHSURE PROPER INSTALLATION.
PERRY! I T E×P I RES DECEr'IBER ~:L. :1_978
I CERTIFY THAT
l: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEI,IERS RHD HELLS AS SET
FORTH BY THE HUHICIPALITY OF AHCHORAGE.
2: I HILL/~HSTRLL THE SYSTEM IH RCCORDRHCE PlITH THE CODES.
F~I~IT LEE _.ULLI VAN
V3. 2
,' AS-BUILT
! her~b~ certify that ! have surveyed the fo]Iow~ng
Anchorage Recording Precinct, Alaska. and that the
improvements situated thereon are wtthfn ~·e prc~:erty
lines and do not overla~ er encroach on the property
lying ~djacent.ihereto, that no knprovement~ On. pr0~-
l:nes or o'~her visible ~aseme~ts on aald property except
ss lndicalcd bc~'eon.
Da~cd at Eagle Rh'er, Alaska
F~OBEF. T' G. JOIfNSO~
SCALE: l:e;l:slered Land Surx'cyor No?'SS0-LS
1" -':Z-~,' / Box 45(I. Ea~fle Rs, er. Alaska
( erlifiei 3rflli,g
A & L DRILLING COMPANY
BOX97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588
OWNER OF LAND
ADDRESS
t4o.S '
~'~c.¢g' I~t~F~. DRAW DOWN FT.
~/~//7r GA~.PER tlR
KIND OF CASING
PERMIT NUMBER ~' 0 I ?_~
/
DEPTll OF WELL [ c~ ,~
STATi~ EEvEL OF WATER FT.
~-~ oo
KIND OF FORMATION:
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· .. FI. to '70
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... Ft. to /d~Ft. ~'J',~,oO
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MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE ....... ~ u ,' -
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTtON ~ : "
B25 L Street. AmaEQ~, Alml~ 99501 ......
ENVIRONMENTAL ENGINEERING DIVISION , ~ ' ,
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES'
DIRECTIONS: Com~et~ ~1 pert; on p~ge 1. Ineamedem re~ue~ will not be I~. Piece a;Iow ten (10) d~y$ for proce~;ng,
AILING ADDRESS
~.'flOPEFIT¥ RESIDENT (I f differe~z f r°m eb°ve~gBUYER ~'~/4P f~/¢ ~./~'~-1 (~ /~ [~'- .~J~ ~ ~ PHONEPHONE
MAILING ADD~E~
I
~ R~LTOWAOENT I PHONE
I
LEGAL DESCRIPTION
TYPE OF B~IDEN~E NUMBEn OF BEDnOO~
~5iNGLE ~ One ~ Four
FAMILY
~ Two ~ Five
~ ~ULTIPLE FAMILY ~ Th~ ~ Six
7. WATER ~U~LY
~ INDIVIDUAL·
[] COMMUNITY
[] PUBLIC UTI LITY
[] Other
· ATTACH WELL LOG. A well log is required for ail wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE*'
~PUBLIC UTI LITY
If ~nd~wdual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010(3/78)
· THIS SIDE FOR OFFICIAL USE ONL. ! ~
DATE RECEIVED
INSPECTION APPOINTMENTS ~.
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR , INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE F-I FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
' []INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verifie~
INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimens[on$:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Sept~c/Holcli.g Tenk IAbeorpfion Area ]Seamer Line I Nea~st Lot Lire
Absorption Area to nearest Lo{ Line
'~. COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE By (Title) / /
LEGAL DESCRIPTION ~'-
72-010 (Rev, 3/7E)
P.O. BOX 4-1276 ANCHORAGE. ALASKA g950g 4~49 BUSINESS PARK BLVD.
Drlnking.Water Analysis Report for Total Coliform Bacteda
TELEPHONE
{C07} 270-4014
TO BE COMPLETED BY WATER SUPPLIER
PUBI:IC WATER SYSTEM: I II I I I I
I.D. NO.
_& ~_,~.~Y
Public Water System Name
Mailing Address
City Slate
MO. Day Year
Zip Code
SAMPLE TYPE:
I-I Routine
[] Check Sample (for routine sample
with lab ref. no.
D Special Purpose
Fl Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
Time Collected
Collected By
I, -~.'~ ~£
TO BE COMPLETED BY LABORATORY
LABORATORY:
CH£H & G£0 LABS OF
NAME
4649 BUSINESS PARK BLVD.
ADDRESS
ANCHORAGE, /~I. ASKA
CITY
Time Received
Analytical Method:
n Fermentation Tube
t~embrane Filter
Lab Ref. No. Result' Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18.310 (3-78)
06-]220 (t~) BACTERIOLOGICAL WATER ANALYSIS RECORD
Oats eouecte~l 9-- 19-78 .__ sou,.
,t, ,,¢,l.,d q-1 q--28 P,,,v'~.--1520- P.,,.
Presumptive ]Omi ]Omi ]emi ]Omi ]Omi ].Omi O.]ml
La;~y Comstruction ~any
~a~lo River, Ala~k~ 995?7
Lot 16 Block 2 ~agle River Heights Su-~tivision
A ~atcr sa.-.~lu va= obtained iron Lot 44 Dlo=k 2 Eagle River
~cightn Su~livision. I ~as =nabXe to locate the well.
Tnereforc~ before approval :~y be grnnted the wall on both
lots z~/st be a~cessibl~ for our inspection.
~o also must have adequate directions to Lot 16 Slock 2
If there are ~ny question,, please co~,tact thin office
at 264-4720e
Sincerely,
Robert C. Pratte R.S.
~ltarian
CC I
P~ople~ Dank and
}~rtgagc LOanSect!on
Pouch 7-007 99510